Age_McDaniel APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
7.1PROPERTY TAX BENEFITS
State Form 43708(R15/1-20) (� 1 5'o QS 1(n7
Prescribed by the Department of Local Government Finance h /t
File Mark
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9.
INSTRUCTIONS: To be filed in person or by mail with the County Auditor of the county where the property is located.
Filing Date: Form must be completed and signed by December 31
Type of benefit requested(Please,cchheckkaall that apply)
L1 vver 65 Deduction from Assessed Valuation f Over 65 Circuit Breaker Credit
Name of applicant(owner or contract buyer)
lit t vv, A. NV c 1blc,,.tn
Is applicant the sole legal or equitable owner? If No,what is his/her exact share or interest? If owned with joint tenant or tenant in common,indicate with whom.
EtV-es ❑No
If name on record is different than that of applicant,indicate below. Do all joint tenants or tenants in common reside on the property?
es ❑No
Name of contract seller Has applicant owned or been buying the property under recorded contract for
at least one(1)year before claiming deduction?
V;Pre—a- ❑No
Address of contract seller(number and street,city,state,and ZIP code) Is the pro y in question:
eal property ❑Mobile home(IC 6-1-1-7)
Taxing district Key number/Legal description Record number Page number
y f c) 1-6 n5 i-C21 / a 6 - o -/C--Ycr- ob 3 . (D(-7?- 0/7
Does applicant reside on p pe y? Assessed value of the property as of current year assessment date(May not exceed$200,000 for Over 65 Deduction or$199,999
�s ❑No [counting just the homestead site]for the Over 6i5 Circuit Breaker Credit received before January 1,2020,and$199.999[all Indiana real
progeny)for the Over
Have you filed for any other deductions? If Yes,what deductions?
es ❑No HO fwe 5'!-PcL-1-k
Have you filed for deductions in any other county? If Yes,what county?
E ,
❑Yes i 1 --o
I/We certify under penalty of perjury that thee above
vebove and foregoing information is true and correct.
Signature of applicant :.../..e.br C::// �" Date(month,day,year) _
Address of applicant (number and street,city,state,and ZIP code)
14(191 nJ 45 o E ✓,ccnc 1 5 Co Jf VV76 Y9
Signature of authorized representative Date(month,day,year)
Address of authorized representative (number and street,city,state,and ZIP code)
Signature of C unp ty Auditor c Date(month, y,4-2 (/0.c>
FILED
JUN 21 2022
DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer GIBSON COUNTY AUDITOR